Understanding the Language of Silence - Sleep, Sleep Behavior and Sleep Disorders. Dr. Amrit Lal

affects sleep patterns, bad sleep hygiene such as irregular sleep-wake hours and addiction to nicotine, caffeine and alcohol and some OTC medications such as anti-histamines (anti-allergy medications) and pain killers (mainly, narcotics), make sleep scenario worse confound in actual life. Instead of helping in the solution of the problem, bad sleep hygiene and certain lifestyle become a part of the problem. Under such conditions, when such so-called “sleep help” options fail to deliver, it may well be to turn to a sleep specialist who is specifically trained in sleep medication and can figure out what lies at the root of a particular sleep disorder to navigate a way to improve both quantity and quality of sleep. The earlier one seeks such help, the better one can manage one’s sleep problem.

      Already, according to one estimate, pertaining to the United States, there are some 37 million old-aged Americans who suffer from frequent sleep disorders which, if ignored, can manifest in a number of serious age-related conditions ranging from arthritis to diabetes and obesity, heart and lung pathology as well as psychiatric disorders like dementia and depression. However, National Sleep Foundation (NSF) of the United States says that it is the poor health of the elderly comes first and is the real trigger to sleep disorders rather than the other way round. But the general consensus of the medical community is that the association between health and sleep disorders is bi-directional - not a one way alley but a two way street – more severe a medical condition, greater the severity of a sleep disorder and vice versa. In addition, let us not forget, some 20 percent of automobile accidents are as a result of some form of sleep disorder like insomnia and sleeping pills to address it, resulting in outright daytime drowsiness caused by night time sleep deprivation or use of sleeping pills. US congressman Patric J. Kennedy who was caught at 3 AM driving erratically admitted having used at night a particular sleep aid (Ambien) with an anti-histamine (Phenergan): “I simply don’t remember getting out of bed, being pulled over by the police, or being cited for the driving infractions,” said Kennedy later on.

      Apart from being an individual health concern, a good night’s sleep is also good for business because a sleep-deprived worker cannot perform optimally. Already, sleep deprivation costs billion of dollars in lost productivity. A 2011 study published in the journal Sleep found that insomnia alone costs $2,280 per worker in lost productivity, adding up to $63.2 billion nationwide in America. According to the Center for Disease Control and Prevention (CDC) in Atlanta, USA, 40.6 million American workers, which is 30% of the civilian workforce in the country, don’t get enough sleep. Also, CDC estimates that the number of sleep deprived Americans is up about 25 percent from 1990. This is to say lack of sleep and high use of prescription and non-prescription anti-sleep regimens have become one of the signature health concerns in America.

      Harvard scientists estimated that in 2011, sleep deprivation costs US companies a staggering $63.3 billion in lost productivity per year because of “presentism” to get paid but operating at sub-par levels. And a poll by Harris Foundation in the United States found that those adults with less than 8 hours sleep reported “their concentration was 70 percent of normal, their accomplishment 76 percent of their capability and their quality of work dropped off by 20 percent.”

      As of today, we still know very little about sleep. At the basic school level very few, if any, hygiene text books provide any kind of information on sleep, in particular, what occurs in the body during sleep and how these changes or sleep deprivation affect our ability to move, think and learn. Most of what we know about sleep we have learnt in the past 30 years or so. But sleep research is recently gaining recognition. It was only in 1995 that American Medical Association recognized Sleep as a specialty. It is a newer field of research and is generally not taught in medical schools, says Dr. Sara Mednick, a psychologist from the University of California Riverside. Although more than 200 sleep disorders centers exist in the United States, experts estimate 95 percent of those suffering from sleep disorders go undiagnosed. May be sleep disorders are generally ignored by the medical community which is more tuned to addressing other types of medical conditions, say, from arthritis to cancer. It is estimated that of the 37 million older adults reporting sleep disorders, only 7 million gets diagnosed with some kind of sleep disorder, leaving 30 millions to fend for themselves through their sleepless nights. This is a great mismatch between the burden of sleep disorders in the elderly and the attention given to them by the medical community – a situation that needs to be redressed. What is, however, important is not just to enable them sleep but sleep well and sleep safely.

      When people cannot sleep well the level of stress is very high. Insufficient sleep degrades performance, focus, agility and concentration and increases proneness to accidents. Center for Disease Control and Prevention (CDC), Atlanta in the US accordingly, has classified insufficient sleep as a Public Health Epidemic, and, in consequence, has emphasized continued public health surveillance of sleep quality, sleep duration, sleep behavior and sleep disorders and their impact on nation’s health.

      ACKNOWLEDGEMENTS

      In writing a book like this I owe debt to all kinds of people. To Dr. Herbert L. Whittier, Professor Emeritus, Institute of International Health, Michigan State University whose academic association for the last two decades I prize the most as a source of great inspiration and professional advice for my work in Africa and in the United States,; to my son, Professor Rajesh Lal, whose very candid suggestions at every stage in the writing of this book, has helped me shape the amorphous into this working presentation. Rajesh suggested a number of revisions in the text resulting in inclusions which I had omitted unwittingly in the first draft of the book.

      To my wife of 50 years, Santosh, for believing in my work and encouragement to complete it. I sincerely thank her for a wonderfully cheerful patience and a teacher’s eye for improving this presentation with her gentle input. You are a princess and I love you wholly.

      Friends, old and new in this country and the countries I have worked for, who read the text of this book and shared their views to format the contents. They are too many to name them individually.

      Thanks to psychologist Dr.(Mrs) Tripti Sakhuja, Dr. Dharminder Lamba and Dr. Ripple Lamba from India who have always helped to keep me going on with my projects – now and in the past.

      Indeed, I am indebted to many others to name them individually. In particular, I want to name Psychiatrist Dr. Kalpana Parshad M.D. and Psychatrist Dr.Arun Munjal M.D. who provided me advice on day-to-day psychiatric issues.

      I want to thank Dr. Srinivas Meka M.D. for his advice and treatment to put new vigor in me to be able to complete this presentation.

      Last but not the least, I like to thank the publishers of this work for their useful input and make it appear in this very attractive format.

      Like my earlier books I have renewed pleasure in writing this book on SLEEP, since my father (Late, Dr. Khushi Ram of Amritsar (Panjab, India) who was a very renowned physician in his time, and had a passion for medical books. He would have loved to see one more book by me on his shelf of medical books.

      THIS BOOK IS DEDICATED

      TO 70 MILLION INSOMNIACS

      IN THE UNITED STATES

      WHO “COUNT SHEEP”

      WHILE REST OF THE

      NATION LIES IN DIVINE

      SLEEP.

      Chapter: 1

      SLEEP - A DIVINE NAP

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      THREE KEY MESSAGES

      1.Sleep is somewhat a period of “quiescence” when all activity ceases; is more easily reversible than being in a state of coma, and there is a reduced responsiveness to external stimuli.

      2.Sleep urge depends upon homeostatic: the balance between the elapsed time we slept and circadian rhythm which determines an ideal time for a restorative sleep.

      3.Sleep hygiene, sleep environment and sleep postures play a great role in how well we sleep.

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      “The bed has become